title: Progesterone elevation does not compromise pregnancy rates in high responders: a pooled analysis of in vitro fertilization patients treated with recombinant follicle-stimulating hormone/gonadotropin-releasing hormone antagonist in six trials.
abstract: OBJECTIVE
  To compare the impact of elevated P during the late follicular phase on the chance of pregnancy in low, normal, and high responders.
  
  
  METHODS
  Retrospective combined analysis from six clinical trials.
  
  
  METHODS
  IVF centers.
  
  
  METHODS
  Women up to 39 years of age with a regular menstrual cycle and an indication for ovarian stimulation before IVF/intracytoplasmic sperm injection.
  
  
  METHODS
  Ovarian stimulation with recombinant (r) FSH in a GnRH antagonist protocol.
  
  
  METHODS
  Ongoing pregnancy rates (OPRs) assessed with the use of univariate and multivariate analyses according to serum P levels ≤ 1.5 ng/mL versus >1.5 ng/mL on the day of hCG administration and compared among low (1-5 oocytes), normal (6-18 oocytes), and high (>18 oocytes) responders.
  
  
  RESULTS
  A total of 157/1,866 women (8.4%; 95% confidence interval [CI] 7.2%-9.8%) had elevated P. Incidence of elevated P increased from 4.5% in low responders to 19.0% in high responders. Overall, OPRs were significantly lower in women with elevated P. Per started cycle, the >1.5 to ≤ 1.5 ng/mL adjusted odds ratio was 0.55 (95% CI 0.37-0.81). OPRs were not impaired in high responders with P elevation and were significantly higher compared with normal responders with P elevation.
  
  
  CONCLUSIONS
  The incidence of elevated P increases with ovarian response, and elevated P at a threshold of 1.5 ng/mL is independently associated with a decreased chance of pregnancy in low to normal responders, but not in high responders, when using an rFSH/GnRH antagonist protocol.
authors.affiliation: Department of Reproductive Medicine and Gynecologic Endocrinology, University Clinic of Schleswig-Holstein, Luebeck, Germany. Electronic address: griesing@uni-luebeck.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Griesinger
authors.forename: Bernadette
authors.initials: B
authors.lastname: Mannaerts
authors.forename: Claus Yding
authors.initials: CY
authors.lastname: Andersen
authors.forename: Han
authors.initials: H
authors.lastname: Witjes
authors.forename: Efstratios M
authors.initials: EM
authors.lastname: Kolibianakis
authors.forename: Keith
authors.initials: K
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D005498:Follicular Phase / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000453:epidemiology / Q000628:therapy; D038622:Internationality; D010062:Ovulation Induction / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D011374:Progesterone / Q000097:blood*; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D005640:Follicle Stimulating Hormone
keywords: GnRH antagonist; Puregon; controlled ovarian stimulation; progesterone; rFSH